Placement of a Jejunal feeding tube through a previously placed PEG or gastrostomy tube has been difficult at best. The current techniques, such as the wire guide method and the drag and pull method, are full of challenges from both the method and device perspective.
The wire guide technique utilizes an airplug to fit over a 0.035″ wire guide that is threaded through a PEG tube and grasped with a biopsy forceps. This method requires that the stomach be filled with air while the endoscope, forceps and wire guide are advanced into the small bowel before the airplug can be removed from the wire guide. Following the airplug removal, a Jejunal feeding tube, also referred to as a jtube, is pushed over the wire guide, through the PEG tube and into place in the small bowel. The forceps holds the distal end of the wire guide within the small bowel during advancement of the jtube. Once the end of the jtube is positioned within the small bowel, the forceps may be uncouple from the wire guide. Thereafter, the wire guide may be removed from the jtube. The forceps is typically left in place while the endoscope is removed from the patient to help hold the jtube in place while the wire guide is removed.
There are several drawbacks to the wire guide method. For example, during removal of the forceps from the wire guide or jtube, the jtube is often dragged back into the stomach. If this occurs, then the procedure must be restarted. In addition, care must be taken to maintain tension on the wire guide during the placement procedure. If adequate tension is not maintained, then the jtube may inadvertently curl within the stomach during or subsequent to removal of the wire guide.
The grab and pull method for Jejunal tube placement likewise has drawbacks and is often unsuccessful. This technique involves pushing a jtube with a thin line (like fishing line) looped through the end thereof. A snare or biopsy forceps, which is advanced through an endoscope, is used to grasp the line. The endoscope and snare/forceps are then used to drag the jtube down into the small bowel. However, it is often difficult to detach the snare/forceps from the jtube without dislodging or removing the jtube from the small bowel. This is because the snare/forceps and jtube are usually covered with mucous and other biological material, which causes adhesion and friction between these components. In addition, the jtube, which is relatively flexible, will often loop within the stomach subsequent to placement, thereby pulling the end of the jtube out of the small bowel.
The drawbacks and shortcomings of the procedures described above are addressed by the novel devices and methods of the present invention.